Provider Demographics
NPI:1295009991
Name:VALLEY MEDI VAN
Entity Type:Organization
Organization Name:VALLEY MEDI VAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NILAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-488-0648
Mailing Address - Street 1:24601 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7222
Mailing Address - Country:US
Mailing Address - Phone:951-488-0648
Mailing Address - Fax:951-488-0064
Practice Address - Street 1:24601 IRIS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-7222
Practice Address - Country:US
Practice Address - Phone:951-488-0648
Practice Address - Fax:951-488-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)